肥厚型心肌病合并心房颤动导管消融术后复发的相关因素分析  

Predictors of atrial fibrillation recurrence after catheter ablation in hypertrophic cardiomyopathy patients with atrial fibrillation

作　　者：闻松男[1] 刘念[1] 李松南[1] 宁曼[1] 康俊萍[1] 吴佳慧[1] 阮燕菲[1] 蒋晨曦[1] 桑才华[1] 汤日波[1] 龙德勇[1] 喻荣辉[1] 白融[1] 杜昕[1] 胡荣[1] 董建增[1] 刘小慧[1] 马长生[1] 

机构地区：[1]国家心血管病临床医学研究中心首都医科大学附属北京安贞医院心血管内科,100029

出　　处：《中华心血管病杂志》2015年第7期589-594,共6页Chinese Journal of Cardiology

基　　金：“十二五”国家科技支撑计划（2013BA109802）;国家自然科学基金（81300146,81470465）

摘　　要：目的探讨国人肥厚型心肌病（HCM）合并心房颤动（房颤）患者导管消融术的疗效及术后心律失常复发的危险因素。方法纳入2005年6月至2013年6月在北京安贞医院行导管消融术的HCM合并房颤患者共40例（阵发性房颤27例，持续性房颤13例）。阵发性房颤的消融策略为双侧环肺静脉隔离（PVI）持续性房颤的消融策略为PVI基础上加行左心房顶部、二尖瓣峡部和三尖瓣峡部线性消融。术后以常规心电图和长程心电图随访患者心律失常复发情况，用回归分析方法甄别与心律失常复发相关的危险因素并检测其预测效力。结果单次消融术后随访（344-18）个月，窦性心律维持率为30％（12／40），64．3％（18／28）的心律失常复发出现在消融术后1年。Cox多因素分析显示左心房内径（LAD）和女性是术后快速房性心律失常复发的独立危险因素（LAD：HR=I．124，95％CI1．051—1．202，P=0．001；女性：HR=3．304，95％CI1．397—7．817，P=0．007）。其中LAD的截断值为43．5mm时的预测敏感度为93．5％，特异度为60．0％；LAD每增加1mm，心律失常复发的风险比为1．095（95％CI1．031～1．163，P=0．003）。结论HCM合并房颤行导管消融术虽安全可行，但单次手术后长期随访的窦性心律维持率较低，大部分心律失常复发出现在术后1年内，左心房内径增大和女性是术后复发的独立危险因素。Objective To evaluate the efficacy of catheter ablation in Chinese hypertrophic cardiomyopathy（ HCM ） patients with atrial fibrillation （AF）, and to determine the risk factors of AF recurrence. Methods This study enrolled 40 HCM patients with AF who underwent primary AF ablation at Beijing Anzhen Hospital from June 2005 to June 2013. Ablation strategy included bilateral pulmonary vein isolation （PVI） for paroxysmal AF （n = 27 ） and PVI plus left atrial roof, mitral isthmus and tricuspid isthmus linear ablations for persistent AF （n = 13 ）. AF recurrence was followed-up by means of electrocardiography or Holter monitoring. Risk factors associated with AF recurrence were determined by a Cox regression model and the predictive power was evaluated by receiver operating characteristic （ ROC ） curve. Results After （34 _＋ 18 ） months follow-up, 30% （ 12/40 ） cases remained in sinus rhythm off antiarrhythmie drug, most AF recurrence （18/28, 64. 3% ） occurred within 1 year post ablation. Multivariate Cox regression demonstrated that left atrial dimension （LAD, HR = 1. 124,95% CI 1. 051 - 1. 202,P =0. 001 ） and female gender （HR =3. 304,95% CI 1. 397 -7. 817 ,P =0. 007） were independent risk factors of AF recurrence. The cut-off value of LAD at 43.5 mm predicted AF recurrence with sensitivity of 93.5% and specificity of 60. 0%. Every 1 mm enlargement in LAD was associated with an increased risk of arrhythmia recurrence （ HR = 1. 095,95% CI 1.031 - 1. 163, P = 0. 003 ）. Conclusions AF ablation in Chinese HCM patients is safe and feasible. However, sinus rhythm maintenance rate is low at long-time follow-up. Most of the recurrent AF occurs within 1 year post AF ablation procedure. Left atrial diameter and female gender are independent risk factors of AF recurrence.

关 键 词：心肌病 肥厚性 心房颤动 导管消融术 复发 

分 类 号：R542.2[医药卫生—心血管疾病] R541.75[医药卫生—内科学]